tbuckley/cabot-search huggingface dataset:
Abstract 13350: Accelerating the Diagnosis of Familial Hypercholesterolemia: A Mixed Methods Analysis of Physician-Patient Communication Needs
Authors: Brian Cheung, Robert Block, Nathan D Wong, Danny J Eapen, Laurence Sperling, Scott McIntosh
Journal: Circulation (2022)

Introduction: Familial hypercholesterolemia (FH) is a common genetic disorder, but fewer than 10% are appropriately diagnosed. Use of electronic health records (EHRs) can potentially improve diagnosis and treatment. Hypothesis Systemwide strategies using the EHR can identify patients who may have FH with the goal of improving communication and preventive treatment. Methods: Our analysis included patients identified as having possible FH utilizing an LDL-C ≥190 mg/dL screen in the EHR. Patients were followed for 6 months, and lipid levels were measured at baseline, 6 weeks, 4 months, and 6 months. Changes in lipid levels were analyzed using paired sample t-tests for normalized data or Wilcoxon Rank Sum Test for skewed data. Our previously reported qualitative data were collected from 5 focus groups, 34 semi-structured key informant interviews, and open-ended survey items from patients and primary care clinicians before and after EHR messages about FH were sent. Results: In 12 patients, the LDL-C (25.3 ± 39.4 mg/dL, 18.7 ± 29.1%; p = 0.029) and total cholesterol/HDL-C (3.8 ± 1.0, 3.2 ± 0.9; p = 0.040) decreased at 4 months after lipid lower therapy initiation. In our previous work, which provides context to these findings, key themes identified were that patients trusted FH resources from the EHR and sought outside resources to educate themselves and their family, empower themselves, and improve their health. Yet, patients did not feel empowered due to the perceived lack of educational resources. Patients concluded that the physician-patient relationship via an EHR facilitates sustainable behavioral changes and treatment adherence. They also found that using the EHR to communicate with clinicians and to get laboratory results was helpful. Conclusion Leveraging the EHR to identify patients with FH can lead to better lipid management. Patients and clinicians can identify methods to improve diagnostic processes and communication channels in the EHR.
Abstract 13820: Four Revelations on the Table of Truth: A Confounding Case of ST Elevation
Authors: Kifah Hussain, Iva Minga, Rupa Patil, Jonathan Rosenberg
Journal: Circulation (2022)

Background: We present a case of a patient with new onset ST elevation on EKG, found to have multiple pathologies on emergent cardiac catheterization. Case: A 81 yo woman with no prior cardiac problems; with syncope 3 days ago, came to the emergency department with worsening left-sided chest pain, that started a few hours earlier. Vitals were within normal limits. She was noted to have left facial ecchymosis, from the fall. She had an otherwise normal physical exam. Her EKG on presentation showed ST elevation in anterior leads with deep T wave inversions. She was planned for emergent cardiac catheterization following noncontrast head CT that showed no intracranial bleed. In the lab, she had no evidence of obstructive epicardial coronary artery disease. However, we noted abnormally slow filling of coronaries (suggestive of microvascular dysfunction) and evidence of a myocardial bridge in the mid-segment of the left anterior descending artery. Since neither of these would explain her acute presentation, a left ventriculogram was performed that showed apical ballooning suggestive of Takotsubo cardiomyopathy and filling defect consistent with thrombus. MRI brain showed acute ischemic stroke involving the right occipital lobe which was likely the physical stressor in her case. Discussion: Takotsubo cardiomyopathy is frequently associated with ST elevations and T wave inversions on EKG. It is hypothesized that microvascular dysfunction may be more common in Takotsubo cardiomyopathy and may explain its increased incidence among post-menopausal women and the correlation with emotional and physical stressors. Myocardial bridge of the left anterior descending artery has been associated with stress cardiomyopathy in up to 76% of cases. Conclusion: This is a rare case of stress cardiomyopathy that presented with both evidence of microvascular dysfunction and prominent myocardial bridge, with all three conditions being diagnosed in the cardiac catheterization lab.
Abstract 14560: Prevalence and Correlates of Echocardiographic Abnormalities in Type 2 Diabetes: Insights From iCaReMe Global Registry
Authors: Mikhail N Kosiborod, Carolyn S Lam, Kamlesh Khunti, Hiddo Lambers Heerspink, Antonio Nicolucci, Shashank Joshi, Peter Fenici, Filip Surmont, Susana Goncalves, Hardik Vasnawala, Estefania Vazquez, Ahmed HADAOUI
Journal: Circulation (2022)

Background: T2D is a major risk factor for cardiovascular (CV) burden. Opportunities for early prevention are often missed due to lack of detection of preclinical end- organ damage. To gain insights on cardiac structural disorders in T2D, we assessed the prevalence of echocardiography (echo) abnormalities and correlates in individuals with T2D enrolled in iCaReMe Registry (NCT03549754) Methods: The iCaReMe is a multinational, observational registry which aims to provide real world data on patient characteristics, disease management, and outcomes in type 2 diabetes, chronic kidney disease and heart failure. We report data of adults (&gt;18 years) with T2D but no known cardiorenal complications at index visit enrolled between December 2020 and December 2021 from 5 countries – Egypt, India, Mexico, Malaysia, and the Philippines. Results: Among 11415 enrolled subjects (mean± SD age, 54.4±11.21years; 59.4% women), the mean±SD glycated hemoglobin (HbA1c) was 8.5±2.17%. Mean±SD systolic and diastolic blood pressure (mm/Hg) were 127.5±15.39 and 75.0±11.77, respectively. Mean duration of T2D was 10.2±8.03 years, 36.3% had history of hypertension (HTN). 43.7% were obese, 39% had high/very high CV risk according to 2019 ESC risk estimation and 29.4% had A2/A3 albuminuria. Of individuals with documented echo data (1506 [13.2%]), 450 (29.9%) had at least one abnormality— 260 (17.3%) left ventricular hypertrophy (LVH), 253 (16.8%) left atrial enlargement (LAE), 65 (4.3%) diastolic dysfunction, 62 (4.1%) pulmonary hypertension, and 57 (3.8%) valvular disease. In multivariate analysis, age and history of HTN were associated with LVH, while age, obesity, history of HTN, T2D duration, and A3 albuminuria category were associated with LAE (Table). Conclusion: Among patients with T2D in real world settings, there was a high burden of preclinical structural heart disease. Older patients with obesity, HTN, longer duration of T2D and proteinuria should be considered for screening.
Abstract 13272: Diabetic Cardiomyopathy as a Coronary Artery Disease Mimic: A Case Report
Authors: Yogesh Chander, Bhanu Duggal, M L Narayan, Pradeep P
Journal: Circulation (2022)

A 49-year-old female presented with complaints of angina and dyspnea on exertion for last 4 months, which caused significant limitation of ordinary physical activity. She had poorly controlled diabetes mellitus type 2 with HbA1C of 10.3%. EKG showed complete LBBB with QRS duration of 180 milliseconds. Echocardiogram was consistent with dilated left ventricle and global hypokinesia of left ventricle with ejection fraction of 25-30%. There was marked reduction in GLS (GLPS average of -7.0%). She underwent coronary angiogram which revealed normal epicardial coronary arteries. 99m Tc-sestamibi SPECT myocardial perfusion imaging (MPI) at rest, demonstrated moderate to severe ischemia involving apical, antero-septal, adjacent anterior wall and adjacent basal 2/3 rd of inferior wall segments of LV myocardium (involving approx.~73% of RCA territory and 57% of LAD territory at 50% uptake threshold). There was wall motion abnormality in above mentioned segments on ECG gated SPECT and estimated LVEF with QGS was ~29±5%. She has been started on anti-ischemic measures, guideline directed therapy for HFrEF and comprehensive diabetes care. Diabetic cardiomyopathy is myocardial dysfunction with normal epicardial coronary arteries and absence of other cardiovascular diseases. It is characterized by myocardial fibrosis and associated systolic dysfunction preceded by diastolic dysfunction. Cardiac insulin resistance leads to advanced glycation end products, microvascular dysfunction etc. Perfusion defects observed during MPI in patients with LBBB may be due to CAD, microvascular dysfunction, or artifacts. In the setting of LBBB, isolated anteroseptal defect has low probability of CAD but presence of perfusion defects in RCA territory and apical region increases probability of ischemic events.In this case, there was ischemia with systolic dysfunction in the absence of any overt clinical coronary artery disease and no other identifiable cause.
Abstract 14607: Discharge Education Based on Teach-Back Method Improves Outcomes in Patients With Heart Failure
Authors: Sunyoung Oh, Ji Yea Lee, HYUN JOO LEE, Eui Geum Oh
Journal: Circulation (2022)

Introduction: Heart failure (HF) is one of the most common causes of hospital readmission. Self-care is essential but challenging task in patients with HF, and self-care deficit is closely related to unplanned readmission and unnecessary health expenditure. Patient centered education using teach-back method (TBM) emerged as a key strategy to prevent patients’ adverse events by improving self-care. This study aims to evaluate the effects of TBM in patients with HF. Hypothesis: HEART program ® , a TBM-based discharge education, will significantly improve self-care, symptom experience, caregiver dependency, and unplanned healthcare utilization. Methods: This was a randomized controlled trial in HF patients with left ventricular ejection fraction ≤50%. Before discharge, the experimental group (EG) received HEART program ® by a trained nurse, while the control group (CG) received usual discharge education. Measures were self-care (self-care maintenance; symptom-perception; self-care management), symptom experience, caregiver dependency at 7-days after discharge, and healthcare utilization (readmission; emergency room visit; hospital contact, etc.) at 1-month after discharge. Outcomes were analyzed with ANCOVA and Chi-squared test using SPSS program 25. Results: A total of 86 patients (EG = 40, CG = 46) completed the study (mean age 61±12 years; mean left ventricular ejection fraction 30±9%; mean duration of illness 4 years; mean hospitalization day 8±7). Self-care (self-care maintenance, F =12.3; symptom perception, F =15.4; self-care management, F =6.0) in the EG significantly improved compared with the CG (all P s&lt;.01). On the other hand, there were no significant differences in symptom experience and caregiver dependency between the two groups (all P s&gt;.05). For healthcare utilization, only hospital contact via telephone was significantly different between the EG and CG (N=1 vs. 8; P =.032). Conclusions: This result indicates that discharge education based on TBM is an effective strategy to improve self-care ability, which could lead to reducing unplanned health expenditure in patients with HF. We suggest that healthcare providers implement TBM education for patients with chronic HF.
Abstract 14482: Clinical Impact of Advances of Short-Term Mechanical Circulatory Support Devices and Therapeutic Strategies in Patients With Cardiogenic Shock
Authors: Takuya Watanabe, Osamu Seguchi, Satsuki Fukushima, Tomoyuki Fujita, Yasumasa Tsukamoto
Journal: Circulation (2022)

Introduction: Although revised US adult heart allocation system has provided the opportunity of urgent heart transplantation and improved clinical outcomes in urgent patients, it may not offer select temporary mechanical circulatory support (MCS) patients the opportunity and adequate time to recover to the point of waitlist removal. Severe donor shortages have increased the need for assessment of reversibility of cardiac function. Advances of MCS devices may provide the longer time to assess the appropriate therapeutic strategy. Hypothesis: The aim of this study was to evaluate the impact of bridge-to-decision (BTD) strategies which used recently developed short-term MCS devices strategies. Methods: We retrospectively reviewed the medical records of 108 patients who received BTD strategies from January 2017 to February 2022. Results: Etiology of cardiogenic shock were myocarditis (35.2 %), idiopathic cardiomyopathy (26.0 %) and ischemic cardiomyopathy (30.5 %). Ninety-three (86.1%) had been used any temporary MCS prior to BTD strategy using short-term MCS devices, including intra-aortic balloon pumping, peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) and low-flow percutaneous VAD. Sixty-five (60.2 %) had been inserted extracorporeal centrifugal-flow pump VAD (CF-VAD group), twenty-eight (25.9 %) had high-flow percutaneous VAD (P-VAD group) including with ECMO (ECPELLA) (50 %), and fifteen (13.9 %) had extracorporeal pulsatile-flow pump VAD (PF-VAD group). Duration of short-term MCS support was 42.5±44.1 days. Twenty-five (23.1 %) needed the conversion to other pumps. Forty-eight (40.7%) were withdrawn for recovery of cardiac function (mean duration to decision; 27.7±23.8 days), other forty-eight (40.7 %) were implanted durable implantable VAD for no-recovery of cardiac function (mean duration to decision; 48.4±40.7 days). Twenty patients (18.5 %) died. Clinical prognosis was comparable in three groups (P=0.943). Conclusions: BTD strategies using recently developed short-term MCS devices provided relatively long-term support duration to decision for definitive therapy, and showed favorable clinical outcomes. However, conversion or exchange to other pumps was needed for long-term support.
Abstract 14533: Molecular Imaging of Fibroblast Activity in Pressure Overload Heart Failure
Authors: Guokun Wang, Qinqin Yang, Shengyong Wu, Xudong Xu, Chao Cheng, suxuan liu
Journal: Circulation (2022)

Introduction: Cardiac fibrosis, mediated by the activation of cardiac fibroblasts, is critical in pressure overload-induced heart failure. Fibroblast activation protein (FAP), specifically expressed by activated fibroblasts, can be visualized by radiolabeled FAP inhibitors (FAPI) PET/CT. Hypothesis: To evaluate whether 68Ga-FAPI-04 could characterize the early stages of cardiac fibrosis in pressure overload heart failure. Methods: Sprague-Dawley rats underwent abdominal aortic constriction (AAC) (n = 12) and sham surgery (n = 10). All rats were scanned with 68 Ga-FAPI-04 PET/CT at 2, 4, and 8 weeks after surgery. Cardiac function was measured by echocardiography. The expression of FAP in the myocardium was detected by immunohistochemistry. Results: Compared with the sham group, the AAC group presented with decreased ejection fraction (EF) and fractional shortening (FS) and increased left ventricular internal dimensions in diastole (LVIDd) and systole (LVIDs) at 4 and 8 weeks (all p &lt; 0.01). The AAC group showed higher 68 Ga-FAPI-04 accumulation in the heart than the sham group at 2, 4, and 8 weeks, respectively (all p &lt; 0.001), and FAPI increased significantly from 2 to 8 weeks. Immunohistochemistry confirmed the higher density of the FAP + area in the AAC group. The intensity of the 68 Ga-FAPI-04 PET signal correlated with the density of the FAP + area on histology (p &lt; 0.001). The expression of the 68 Ga-FAPI-04 at 4 weeks correlated with the deterioration of cardiac function at 8 weeks (EF: R = -0.87; FS: R = -0.72; LVIDd: R = 0.77; LVIDs: R= 0.79; all p &lt; 0.001). The AAC group also showed an increased 68 Ga-FAPI-04 signal in the liver, peaking at 4 weeks and then declining. Cardiac and liver PET signals directly correlated at 4 weeks in the AAC group (R = 0.69, p = 0.0010). A combination of the FAPI intensity in the heart and liver at 4 weeks better predicted the deterioration of cardiac function at 8 weeks. Conclusion: The activated fibroblasts in the heart and liver after pressure overload can be monitored by 68 Ga-FAPI-04 PET/CT. This imaging technique reveals an early fibrotic link in cardio-liver interactions and could better predict nonischemic heart failure prognosis.
Abstract 13439: Trends in Spending for P2Y12 Inhibitors by Medicare and Medicaid
Authors: Mohammed Essa, Joseph S Ross, Sanket Dhruva, Nihar R Desai, Robert W Yeh, Kamil Faridi
Journal: Circulation (2022)

Introduction: Use of a P2Y12 inhibitor (P2Y12i) is standard of care for many conditions related to atherosclerotic cardiovascular disease. The more potent P2Y12is, prasugrel and ticagrelor, lead to improved outcomes in MI patients compared to clopidogrel. Generic prasugrel became available in 2017, while ticagrelor remains brand-name. The impact of generic P2Y12i availability on Medicare and Medicaid program spending is unknown. Methods: We evaluated P2Y12i total claims and inflation-adjusted spending in millions (M) of dollars using the 2015-2020 Medicare Part D and Medicaid prescription drug spending datasets. Total cost savings were estimated by switching from ticagrelor to generic prasugrel and clopidogrel. Results: From 2015 to 2020, total P2Y12i spending increased by Medicare (543M to 604M) and Medicaid (61M to 83M), although total claims decreased. In 2015, generic clopidogrel was the most prescribed P2Y12i within the Medicare program (94.2% of claims) and contributed the largest portion of total costs (45.0%). By 2020 ticagrelor contributed to most Medicare costs for P2Y12is (62.0%) despite constituting only 6.9% of claims (Figure). Generic prasugrel constituted 2.2% of Medicare P2Y12i claims in 2020 and contributed to 6.0% of total costs. Total 2020 Medicare savings by switching from ticagrelor to generic prasugrel or clopidogrel would have been 270M and 361M, respectively. In Medicaid, brand-name prasugrel had the largest contribution to costs in 2015 (48.1%) and ticagrelor constituted the most costs in 2020 (80.3% with 9.8% of claims). Total 2020 Medicaid savings by switching from ticagrelor to generic prasugrel or clopidogrel would have been 59.0M and 65.5M in 2020, respectively. Conclusions: Brand-name ticagrelor constitutes &gt; 60% of total 2020 P2Y12i costs in Medicare and Medicaid, despite being used in &lt; 10% of claims. Use of generic prasugrel remains low, despite its efficacy and potential to reduce prescription drug spending.
Interim Recommendations for Use of Bivalent mRNA COVID-19 Vaccines for Persons Aged ≥6 Months — United States, April 2023
Authors: Danielle L. Moulia, Megan Wallace, Lauren E. Roper, Monica Godfrey, Hannah G. Rosenblum, Ruth Link-Gelles, Amadea Britton, Matthew F. Daley, Sarah Meyer, Katherine E. Fleming-Dutra, Sara E. Oliver, Evelyn Twentyman
Journal: MMWR Morbidity and Mortality Weekly Report (2023)

Throughout the national public health emergency declared in response to the COVID-19 pandemic, CDC, guided by the Advisory Committee on Immunization Practices (ACIP), has offered evidence-based recommendations for the use of COVID-19 vaccines in U.S. populations after each regulatory action by the Food and Drug Administration (FDA). During August 2022-April 2023, FDA amended its Emergency Use Authorizations (EUAs) to authorize the use of a single, age-appropriate, bivalent COVID-19 vaccine dose (i.e., containing components from the ancestral and Omicron BA.4/BA.5 strains in equal amounts) for all persons aged ≥6 years, use of bivalent COVID-19 vaccine doses for children aged 6 months-5 years, and additional bivalent doses for immunocompromised persons and adults aged ≥65 years (1). ACIP voted in September 2022 on the use of the bivalent vaccine, and CDC made recommendations after the September vote and subsequently, through April 2023, with input from ACIP. This transition to a single bivalent COVID-19 vaccine dose for most persons, with additional doses for persons at increased risk for severe disease, facilitates implementation of simpler, more flexible recommendations. Three COVID-19 vaccines are currently available for use in the United States and recommended by ACIP: 1) the bivalent mRNA Pfizer-BioNTech COVID-19 vaccine, 2) the bivalent mRNA Moderna COVID-19 vaccine, and 3) the monovalent adjuvanted, protein subunit-based Novavax COVID-19 vaccine.* As of August 31, 2022, monovalent mRNA vaccines based on the ancestral SARS-CoV-2 strain are no longer authorized for use in the United States (1).
<i>Notes from the Field</i>: Increase in Meningococcal Disease Among Persons with HIV — United States, 2022
Authors: Amy B. Rubis, Rebecca L. Howie, Daya Marasini, Shalabh Sharma, Henju Marjuki, Lucy A. McNamara
Journal: MMWR Morbidity and Mortality Weekly Report (2023)

Meningococcal disease, caused by the bacterium Neisseria meningitidis, is a sudden-onset, life-threatening illness that typically occurs as meningitis or meningococcemia.The most common signs and symptoms of meningitis include fever, headache, and stiff neck; the most common signs and symptoms of meningococcemia are fever, chills, fatigue, vomiting, diarrhea, cold hands and feet, and severe aches or pain.*Quadrivalent meningococcal conjugate vaccination (MenACWY) is routinely recommended for adolescents and persons at increased risk for meningococcal disease (1), including those with HIV.In 2016, a 2-dose series of MenACWY was recommended by the Advisory Committee on Immunization Practices (ACIP) for persons with HIV and incorporated into the U.S. immunization schedule.Coverage among persons with HIV, however, remains low: in a study of administrative claims data during January 2016-March 2018, only 16.3% of persons with HIV received ≥1 doses of MenACWY vaccine within 2 years after their diagnosis (2).This report describes an increase in meningococcal disease among persons with HIV in the United States in 2022.Data are typically finalized in the fall of the next year; therefore, this report is based on preliminary data for 2022.Meningococcal disease cases are reported through the National Notifiable Diseases Surveillance System, with additional epidemiologic information and isolates obtained through Enhanced Meningococcal Disease Surveillance.Isolates are characterized using whole genome sequencing to determine serogroup and molecular typing information.This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.† During 2017-2021, five to 15 meningococcal disease cases were reported each year among persons with HIV, representing 1.5%-4.3% of all meningococcal disease cases annually (Figure).Based on preliminary data, 29 meningococcal disease cases have been reported among persons with HIV in 2022, accounting for 9.8% of all cases.This case count might increase when reporting is complete.